Degenerative cervical myelopathy is the leading cause of spinal cord injury in adults, affecting nearly 1 in 10 people at some point in their lives. The condition results from a gradual and progressive compression of the spinal cord in the neck due to disc disease, unstable bone movement or ligament growth in the spinal canal. If left untreated, the natural history of the disease is an increasing loss of dexterity and function in the hands, deterioration of balance and bladder function, and eventually quadriparesis. Once diagnosed, the recommended treatment is usually surgery, and early intervention is essential to promote recovery and maintain quality of life. Read on to learn how to spot the early signs of DCM and explore possible treatment options.
Causes of DCM
The following factors may increase your risk of developing DCM:
- Age – DCM is commonly diagnosed in patients over 50, and it can be especially prevalent in those over 70
- Gender – Men are three times more likely to develop DCM than women
- Smoking – Smoking dramatically increases your risk of arthritis anywhere in the spine
- Repetitive injury or trauma – Some people, such as elite athletes, can develop early arthritis in the cervical spine due to overuse or excessive force
- Musculoskeletal conditions – Diseases that can affect metabolism and bone development, such as rheumatoid arthritis and ankylosing spondylitis, can accelerate changes in the neck that lead to DCM
- Ossification of the posterior longitudinal ligament – OPLL occurs when the ligament that connects and stabilizes the bones of the spine becomes thicker and less flexible, often due to hereditary or genetic factors
For some people, the appearance of DCM is inevitable. However, most people can take steps to reduce their risk later in life. These measures include:
- stay active
- Maintain a healthy BMI
- Avoid smoking
- Control other medical problems
- Avoid occupational hazards that can lead to overuse or neck injuries
“If you have DCM, you want to get out of any environment that puts increased pressure on your neck,” says Jamie Wilson, MD, FRCS, Nebraska Medicine neurosurgeon and DCM researcher. “Additionally, it’s important to avoid contact sports, roller coasters, or horseback riding — anything that could cause sudden or extreme movements of your neck.”
Early signs of DCM include:
- Numbness and tingling in the hands and fingers
- Dexterity issues or difficulty with fine motor skills, such as difficulty buttoning a shirt, writing, or sewing
- Walking and balance problems, especially on uneven ground
- Radicular pain in the arm, or pain that radiates down the arm
As the disease progresses, it can also lead to problems with bladder function.
DCM is often confused with other conditions, such as peripheral neuropathy or carpal tunnel syndrome, which are also very common. If in doubt, a prompt assessment by a qualified spine specialist is recommended, especially for adults over 50. Early diagnosis and treatment can help you avoid permanent damage and loss of function.
DCM processing options
The standard diagnostic tools to confirm if someone has DCM is an MRI, as well as a full exam. Patients with mild impairment can be monitored, and many can see improvement with non-surgical measures like physiotherapy. However, in most cases of moderate to severe impairment, surgery is recommended as a definitive treatment.
“Once a diagnosis of DCM has been made and you have reached a certain level of functional impairment, there is only one treatment that has been shown to be effective, and that is decompressive surgery,” explains Dr. Wilson. “No other non-operative treatment or measure has been shown to be effective, and if you delay treatment and deteriorate, the potential for recovery after surgery also worsens.”
Decompressive surgery is done to relieve pressure on the spinal cord and, in some cases, to reconstruct areas of additional weakness. This may include removing discs and placing a bone graft into the disc space to open it up, as well as correcting spinal misalignment or reconstructing an area of the spine with titanium screws and stem implants. Most patients only need surgery once, but some may need additional surgery on untreated areas of the spine as they age.
“If you have any of the above symptoms, it is important to seek prompt medical attention and imaging, if only for your peace of mind, as the potential downsides of an untreated DCM may be devastating,” says Dr Wilson. “I urge all adults – especially those of retirement age or older – to be alert to these symptoms and to speak to a qualified healthcare professional if they have any concerns.”
For more information or to schedule an appointment with the Complete Spine Program, call 800.922.0000.
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